Emotion regulation is robustly associated with perinatal depressive symptoms in a Swedish national cohort

Abstract Perinatal depression (PeriND) has serious consequences for mothers and children, yet early detection is challenging. Emotion regulation (ER) is increasingly recognized as a key factor for maternal mental health; however, associations with depressive symptoms during the perinatal period remain insufficiently understood. In this prospective, population-based Swedish cohort study ( N = 623), we examined whether ER difficulties in the second trimester, assessed via the Difficulties in Emotion Regulation Scale-16 (DERS-16) were associated with depressive symptoms across seven perinatal time points (24–34 and 36–42 weeks antenatal; 1–4, 6–13, 14–23, 24–35 and 36–42 weeks postnatal) as measured by the Edinburgh Postnatal Depression Scale. Higher ER difficulties were significantly associated with elevated depressive symptoms during pregnancy to 14–23 weeks postnatal, independent of confounders. ER difficulties also differed between PeriND symptom trajectories, with higher scores in early and late postnatal-onset groups. These findings highlight ER assessed in the second trimester as a potential vulnerability marker for PeriND, with the DERS-16 offering promise for early risk detection. Targeting ER may provide a promising strategy for mitigating perinatal mental health risks.